Provider Demographics
NPI:1083750137
Name:DAWN MCCRACKEN M.D. PC
Entity Type:Organization
Organization Name:DAWN MCCRACKEN M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-736-2481
Mailing Address - Street 1:3379 PITTSBURGH RD
Mailing Address - Street 2:BOX 621
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0621
Mailing Address - Country:US
Mailing Address - Phone:724-736-2481
Mailing Address - Fax:724-736-2483
Practice Address - Street 1:3379 PITTSBURGH RD
Practice Address - Street 2:BOX 621
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-0621
Practice Address - Country:US
Practice Address - Phone:724-736-2481
Practice Address - Fax:724-736-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058231L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMC847087Medicare ID - Type Unspecified
PAG23956Medicare UPIN